Influenza A/H1N1 vaccination of patients with SLE: can antimalarial drugs restore diminished response under immunosuppressive therapy?

Author(s):Show less -

Borba, Eduardo F. ^[1] ; Saad, Carla G. S. ^[1] ; Pasoto, Sandra G. ^[1] ; Calich, Ana L. G. ^[1] ; Aikawa, Nadia E. ^{[1, 2]} ; Ribeiro, Ana C. M. ^[1] ; Moraes, Julio C. B. ^[1] ; Leon, Elaine P. ^[1] ; Costa, Luciana P. ^[1] ; Guedes, Lissiane K. N. ^[1] ; Silva, Clovis A. A. ^{[1, 2]} ; Goncalves, Celio R. ^[1] ; Fuller, Ricardo ^[1] ; Oliveira, Suzimara A. ^[3] ; Ishida, Maria A. ^[4] ; Precioso, Alexander R. ^[5] ; Bonfa, Eloisa ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Div Rheumatol, BR-05403010 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Paediat Rheumatol Unit, BR-05403010 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Dept Pathol, BR-05403010 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Fac Med, Adolfo Lutz Inst, BR-05403010 Sao Paulo - Brazil

^[5] Butantan Inst, Sao Paulo - Brazil

• Document type: Journal article
• Source: RHEUMATOLOGY; v. 51, n. 6, p. 1061-1069, JUN 2012.
• Web of Science Citations: 24

Abstract

Objective. To assess the efficacy and safety of pandemic 2009 influenza A (H1N1) in SLE under different therapeutic regimens. Methods. A total of 555 SLE patients and 170 healthy controls were vaccinated with a single dose of a non-adjuvanted preparation. According to current therapy, patients were initially classified as SLE No Therapy (n = 75) and SLE with Therapy (n = 480). Subsequent evaluations included groups under monotherapy: chloroquine (CQ) (n = 105), prednisone (PRED) epsilon 20 mg (n = 76), immunosuppressor (IS) (n = 95) and those with a combination of these drugs. Anti-H1N1 titres and seroconversion (SC) rate were evaluated at entry and 21 days post-vaccination. Results. The SLE with Therapy group had lower SC compared with healthy controls (59.0 vs 80.0%; P < 0.0001), whereas the SLE No Therapy group had equivalent SC (72 vs 80.0%; P = 0.18) compared with healthy controls. Further comparison revealed that the SC of SLE No Therapy (72%) was similar to the CQ group (69.5%; P = 0.75), but it was significantly reduced in PRED epsilon 20 mg (53.9%; P = 0.028), IS (55.7%; P = 0.035) and PRED epsilon 20 mg + IS (45.4%; P = 0.038). The concomitant use of CQ in each of these later regimens was associated with SC responses comparable with SLE No Therapy group (72%): PRED epsilon 20 mg + CQ (71.4%; P = 1.00), IS + CQ (65.2%; P = 0.54) and PRED epsilon 20 mg + IS + CQ (57.4%; P = 0.09). Conclusion. Pandemic influenza A H1N1/2009 vaccine response is diminished in SLE under immunosuppressive therapy and antimalarials seems to restore this immunogenicity. (AU)

• FAPESP's process: 10/10749-0 - Anti-influenza H1N1/2009 vaccine in autoimmune rheumatic diseases patients
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Regular Research Grants